I feared moments like this patient’s comment, where I, as the least superior member of the team, would face the conflict of wanting to step up to avoid being a bystander to sexism but also respect the team’s chain of command.
But now, at this 66-year-old patient’s bedside, my composure was gone. The alignment of only two demographic details, age and sex, in a universe of possible details vaulted this patient into universal importance. What sideswiped my caretaking ability was not the patient’s “ism”s. It was a selfish flood of empathy.
This patient, this 66-year-old man with chest pain for a day, is not my dad. My dad does not have poorly healed scars on his stomach. My dad is not bleeding into his abdomen. My dad is not hemodynamically unstable, with low blood pressure and increasing signs of organ damage. My dad is breathing easily at work hundreds of miles away, not being transferred to the intensive cardiac care unit after some other medical trainee performed violent chest compressions.
But the concordance, however tenuous, between this patient and my dad was something I was not prepared to process. Nothing in my tool kit for politically challenging patients prepared me for this. I had never even considered the possibility that my caregiving skills would be compromised because a patient reminded me of someone I loved.
My mental preparation and professional development for my clinical year had been focused on finding a balance between being myself and being professional. Should my ear-piercing stay in? Is my Spanish too offensively bad to use? Will patients see the L.G.B.T.Q.-rainbow sticker on my badge and make assumptions about my caregiving? These are the questions I prepared myself to answer, on the spot and in the moment, only to snap back into my best professional, equitable-care-giving self. I was prepared to deal with otherness, not closeness.
I have a cogent and academic vocabulary that helps me navigate sexism, racism, homophobia and their manifestations in tattoos. I have a professional skill set for checking my biases. I am passionate that medicine never be used as a weapon in the form of care inequities. But this experience of not-dad transference revealed to me that politics won’t be the only barrier to my care giving. What happens when someone in my care reminds me of my boyfriend, my brother, my best friend?
I have a medical vocabulary, algorithms and protocols, equipment I’m trained to use when a patient needs them. But for my family and friends, none of this helps. It doesn’t change the reality of illness, the reality of people you’ve known for much longer than a single hospital admission becoming victims to the biology in a textbook and protocols at your workplace.